Outback Eye Problems

It is important to know how to diagnose and treat eye injuries in the wilderness. The eyeball sits within a bony cavity of the skull called the eye socket or orbit. The parts of the eyeball most likely to be injured or subject to illness in the backcountry are:

* The cornea: a clear, transparent, thin window-like covering over the front of the eye.
* The conjunctiva: a delicate mucous membrane that covers the white part of the eyeball and lines the undersurface of the eyelids.
* The lens: a structure which sits behind the cornea and focuses light onto the retina.
* The retina: a thin movie-screen-like structure that makes up the back wall of the eye.

PREVENTION

Ruptured Eyeball

A blow to the face can rupture the eyeball and fracture one or more of the skull bones that form the orbit. The eyeball can also be ruptured by an object that is stuck or driven into the eye. A ruptured eyeball is a medical emergency that requires immediate evacuation for surgery on the eye.

SIGNS AND SYMPTOMS

* Vision loss, ranging from blurred sight-to total blindness.
* Pain.
* Dilated pupil that does not react to changes in light.
* Blood in the eye.
* The fluid in the eye may have leaked out, giving it a collapsed or flattened appearance.

With an orbital bone fracture, the victim may have double vision and feel numb above the eyebrow or over the cheek.

TREATMENT

1 .Do not remove a foreign object that penetrates the eye, as this may cause further injury. Stabilize the object in place by securing rolled-up dressings on either side of the object and taping them together. Another technique is to take several layers of 4 by 4 inch gauze pads and cut a hole in the center large enough to pass over the foreign object without putting pressure on it. Then cover the eye with a paper cone, cup, or other protective object and secure this in place with a bandage. Be careful not to put pressure on the eye.
2. If the eyeball is ruptured, but there is no penetrating object, cover the eye with a paper cup or cone and secure this in place with a bandage. Remember not to put any pressure on the eye.
3. Patch the other eye to reduce eye movements (when one eye moves, the other moves with it), unless the victim has to walk out under his own power.
4. Administer oral antibiotics if you have them available. Do not place any drops, medicine or fluid directly into the eye.
5. Evacuate the victim to a medical facility as soon as possible.

Hyphema (Blood Behind the Cornea)

A blow to the eye can produce bleeding behind the cornea without rupturing the eyeball. If the bleeding is severe, the victim can eventually become blind.

SIGNS AND SYMPTOMS

A visible layer of blood will settle behind the cornea and be noticeable 6 to 8 hours after injury.

TREATMENT

1. The eye should be patched closed with a 4X4" sterile gauze pad and tape.
2. Evacuate the victim immediately to medical care, keeping the head elevated and in an upright position.

Retinal Detachment

Trauma to the eye can also cause the retina to become detached from the back of the eye.

SIGNS AND SYMPTOMS

* Sudden, painless loss of vision in one eye.
* Light flashes or floating spots may appear in the victim's field of vision or the victim may describe the sensation that a dark curtain is obstructing part of his field of view. I happened 2 days ago with a guy my dada works with.

TREATMENT

A detached retina requires surgical repair. Seek immediate medical care.

Scratched Eye

The clear covering over the front of the eye is called the cornea. It is easily scratched or abraded.

SIGNS AND SYMPTOMS

* The victim feels as if he has sand in his eye.
* The eye will usually appear bloodshot.
* The eye waters.
* Slight blurring of vision.
* Intense pain, made worse by blinking the eyes.
* Sensitivity to light.
* Close inspection of the cornea may show a slight irregularity on its surface.

TREATMENT

1. Check the eyes carefully for foreign material, making sure to examine under the upper lid. To examine under the upper lid, have the victim look downward as you grasp the eyelashes with your thumb and finger. Using a cotton tipped applicator, place the end of the applicator in the middle of the upper lid. Using the applicator as a fulcrum, pull the lid forward and upward, causing it to fold back over the applicator (inside out) exposing the undersurface of the lid.
2. Cool compresses may help relieve some of the irritation.
3. If available, apply antibiotic eyedrops such as tobramycin 2 to 3 drops every 2 to 3 hours while awake, for 2 to 3 days.
4. Administer pain medication such as acetaminophen and have the victim rest his eyes as much as possible. Mostof the time,the injury heals itself in 1-2 days
5.Patching the eye with an eye patchor bandage for 24 hours may help reduce pain. If nothing else is avalible the eye can be taped shut or sunglasses can be worn. Eye shouldn't be patched if there's signs of infection green-yellow discharge swelling or fever.

Snow blindness

Is a sunburn of the eye from intense UV at high altitudes or while traveling on snow covered ground The sunburn causes a corneal abrasion. Unfortunately the victim doesn't realize it until it is too late, because the signs and symptoms of snow blind are delayed for 6 hours from the time of exposure to the light.

SIGNS AND SYMPTOMs

See Scratched Eye above

TREATMENT

See Scratched Eye above

Subconjunctival hemorrhage sometimes occurs from physical exertion, coughing, puking or strangilation but is not a serious condition.

SIGNS AND SYMPTOMS

* Blood clots (or what looks like a red film)on the white part or the eye.

TREATMENT

No treatment is necessary, as the hemorrhage will resorb by itself over a few weeks time.

Small Foreign Bodies

Most foreign bodies in the eye are tiny particles which can easily be removed. If the foreign body is imbedded in the eye and can not be removed by irrigation or with the corner of a moistened cloth or cotton swab or magnet leave it in place and seek medical attention as soon as possible. Do not attempt to remove a foreign body with any sharp or stiff object, as this can produce more damage.

SIGNS AND SYMPTOMS

* The victim may notice a "spot" in his vision and feel as if he has a piece of sand in his eye.
* The foreign body should be visible when you look into the eye with a bright light.

TREATMENT

1. If a foreign body enters the eye, but is not imbedded in the eyeball, attempt to remove it by irrigating the eye with a stream of disinfected water.
2. If irrigation does not remove the foreign body, careuly attempt to lift the material out gently with a moistened cotton swab or cloth.
3. Sometimes the foreign body will lodge underneath the upper eyelid. Examine under the eyelid by everting it.
4. After objects are removed from the eye, victims often report feeling as if something is still in their eye. This is usually caused by small scratches on the surface of the cornea. Treat the same as for a scratched eye (see above).

Conjunctivitis (Pink Eye)

Conjunctivitis is an infection or inflammation of the conjunctiva, a mucous membrane that covers the white part of the eyeball and lines the undersurface of the eyelids. It can be caused by a virus or bacteria, or by allergic or toxic agents. The most common cause is viral infection, and the condition is often associated with other cold symptoms.

SIGNS AND SYMPTOMS

*Red, itchy eye(s)
* Yellow or green discharge from the eyes.
* Crusted eyelashes.
* Swollen eyelids.

TREATMENT

1. Irrigate the eye with disinfected water.
2. Apply antibiotic eyedrops, such as tobramycin, 2 to 3 drops every 2 to 3 hours while awake.

Styes or Abscesses

A sty is an infection or abscess of the sebaccous gland of an eyelash or eyelash follicle. it usually begins as a red nodule that progresses into a painful pustule within a few days.

SIGNS AND SYMPTOMS

* Swollen, red, painful eyelid.
* Eventually a pustic forms on the edge of the eyelid.

TREATMENT

When a sty begins to develop, apply warm, moist compresses to the eyelid for 30 minutes four times a day until the sty either disappears or enlarges and comes to a head. If it comes to a head, but does not drain spontaneously, seek medical attention.
2. If the victim is more than 48 hours from medical care and the infection is progressing to include the cheek or forehead, lance the sty carefully with a scalpel or pin. (Make sure you sterilize the pin by either boiling it in water for 5 minutes, heating it over a flame, or putting it in Betadine) Start antibiotic therapy with erythromycin, or Keflex

Bush Medic Tricks

If you don't have sunglasses and are traveling a bright area (tundra, Desert, High altitudes) Make some as shown in the pic, or use a strip of duct tape folded on its self, or soot from a campfire or mud smeared around eyes

Drops of tea squeezed from a non herbal tea bag may help sooth the eye and relieve pain.

You can use the ziplock baggy trick I discussed in the cleaning the wound Medical module to irrigate the eye the stream can be directed around the eye better

If your the group medic pack a blue light or a blue chemical light and some fluorescent strips (fluorescein sodium opthalmic strips) abrasions and debris are easily found